The demands and capacities model II: Clinical applications

doi:10.1016/0094-730X(90)90015-K

Journal of Fluency Disorders

Volume 15, Issue 3, June 1990, Pages 143-157

https://doi.org/10.1016/0094-730X(90)90015-K Get rights and content

Abstract

The Demands and Capacities Model is first briefly described, then applied to the assessment of fluency in children and to early intervention and prevention treatment. Assessment procedures are designed to evaluate (1) a child's capacities for fluency and (2) environmental demands placed on the child's fluency in four domains: motoric, linguistic, social/emotional, and cognitive. Early intervention and prevention therapy based on the DC model is designed to (1) increase the child's capacity to produce fluent speech and (2) decrease the demands placed on the child's fluency by frequent listeners in the same domains.

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Cited by (111)

Erasmus clinical model of the onset and development of stuttering 2.0
2024, Journal of Fluency Disorders
A clinical, evidence-based model to inform clients and their parents about the nature of stuttering is indispensable for the field. In this paper, we propose the Erasmus Clinical Model of Stuttering 2.0 for children who stutter and their parents, and adult clients. It provides an up-to-date, clinical model summary of current insights into the genetic, neurological, motoric, linguistic, sensory, temperamental, psychological and social factors (be it causal, eliciting, or maintaining) related to stuttering. First a review is presented of current insights in these factors, and of six scientific theories or models that have inspired the development of our current clinical model. Following this, we will propose the model, which has proven to be useful in clinical practice. The proposed Erasmus Clinical Model of Stuttering visualizes the onset and course of stuttering, and includes scales for stuttering severity and impact, to be completed by the (parent of) the person who stutters. The pathway of the model towards stuttering onset is based on predisposing and mediating factors. In most children with an onset of stuttering, stuttering is transient, but if stuttering continues, its severity and impact vary widely. The model includes the circle of Engel (1977), which visualizes unique interactions of relevant biological, psychological, and social factors that determine the speaker’s experience of stuttering severity and its impact. Discussing these factors and their interaction with an individual client can feed into therapeutic targets. The model is supplemented by a lifeline casus.
Perceived evolution by parents of preschoolers who stutter and received preventive treatment
2023, Revista de Logopedia, Foniatria y Audiologia
I) Describir los resultados preliminares de un estudio sobre la evolución percibida por los padres de los niños entre los 2.11 y 5.11 años que tartamudeaban, después de recibir tratamiento preventivo de tartamudez con apoyo de los progenitores, II) conocer los recursos comunicativos aprendidos por los niños y sus padres respecto al tartamudeo y III) descubrir el grado de satisfacción de los padres con el tratamiento. El estudio se realizó en ILD, centro especializado en trastornos de fluidez.
Se administró un cuestionario a 18 padres, cuyos hijos habían sido dados de alta después de la terapia. El 77.8% (n = 14) de los participantes fueron niños y el 22.2% (n = 4) niñas. Los niños seleccionados que participaron en el estudio tenían una edad comprendida entre cuatro y ocho años (M = 5.90, DT = 1.25).
En las respuestas cabe destacar que: I) El 88.9% de los niños mantuvieron un habla fluida, II) y el 72.2% no presentó ni tuvo bloqueos, el 82.3% no experimentó tensión en la garganta, III) los niños mostraron disfluencias cuando estaban cansados (n = 6) o estresados (n = 5), IV) los niños mejoraron en el habla, en la conducta y adoptaron buenas estrategias ante las disfluencias o los bloqueos, V) tanto los niños como los padres utilizaron los recursos aprendidos durante el tratamiento, VI) se realizaron sesiones individuales de padres y de seguimiento y la mayoría de ellos recibió pautas a seguir en caso de recaídas, y VII) el 94.4% de los padres, quedaron satisfechos con los resultados del tratamiento.
Los resultados preliminares indican que el tratamiento realizado con los niños preescolares con apoyo de sus padres ayudó a mejorar la fluidez del habla, su conducta, las actitudes positivas en la conversación y las habilidades de comunicación padres-hijo.
The aim of this article is (a) to describe the progress perceived by parents of children between the ages of 2.11 and 5.11 who stuttered, after receiving preventive treatment for stuttering with parental support; (b) to assess the communicative resources learned by the children and their parents regarding stuttering and (c) to find out their level of satisfaction with treatment. The study was carried out at ILD, a specialized centre for fluency disorders.
A questionnaire was administered to 18 parents, whose children had been discharged after therapy. Of the sample, 77.8% (n = 14) were boys and 22.2% (n = 4) girls. The selected children participating in the study were aged between 4 and 8 years (M = 5.90, SD = 1.25).
From the responses it was noted that: (I) 88.9% of the children maintained fluent speech; (II) and 72.2% did not present or have blocks, 82.3% did not experience throat tension; (III) the children continued to present disfluencies when they were tired (n = 6) or stressed (n = 5); (IV) the children improved in speaking, behavior and had adopted good strategies in dealing with disfluencies or blocks; (V) both children and parents frequently used the resources learned during treatment; (VI) individual parent and follow-up sessions were conducted and most of them received guidelines to follow in case of relapses; and (VII) 94.4% of parents were satisfied with treatment outcomes.
Results indicate that the treatment conducted with the preschool children, with support from their parents, contributed to improvements in speech fluency, behavior, positive conversational attitudes, and parent–child communication skills.
Adult recasts as fluency-facilitators in preschoolers who stutter: Evidence from FluencyBank
2023, Journal of Fluency Disorders
Adult conversational recasts are based on child platform utterances that contain errors (e.g., Child: “Me going.” Adult: “Yes, you are going”), and recasts are effective in the child language literature. For many years, adult recasts of preschoolers’ stuttered utterances were surmised as fluency-facilitating, but to date, no evidence has been reported to support their efficacy. The purpose was to investigate the natural occurrence of, and the fluency-facilitating potential of, recasts produced by caregivers and clinicians/examiners in free-play interactions transcribed from audio or video recordings on FluencyBank. Forty-three participants with a median age of 38 mo (3;2) (Range=28–73 mo), including 32 boys and 11 girls were selected from five databases, and recasts which were near-imitations and simple recasts as per Weiss (2002) were identified. One database chosen was the Illinois project, to include a subgroup of persistent (n = 9) and recovered children (n = 9). In the 43 participants, significantly (p < 0.0001) fewer stutters and lower percent syllables stuttered (%SS) were observed in post-recast utterances (4%SS) as compared to post-nonrecast utterances (12.5%SS). The CWS-persistent subgroup (n = 9) did not fit the group trend of the 34 others who significantly differed in stuttering frequency post-nonrecast versus postrecast. Findings are taken to mean that adult conversational recasts of preschoolers’ stuttered utterances are fluency-facilitating, and interpretations are addressed.
The effect of manual movements on stuttering in individuals with down syndrome
2023, Journal of Fluency Disorders
Stuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients’ needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.
Eighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.
The experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.
Individual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.
Anomalous network architecture of the resting brain in children who stutter
2018, Journal of Fluency Disorders
We combined a large longitudinal neuroimaging dataset that includes children who do and do not stutter and a whole-brain network analysis in order to examine the intra- and inter-network connectivity changes associated with stuttering. Additionally, we asked whether whole brain connectivity patterns observed at the initial year of scanning could predict persistent stuttering in later years.
A total of 224 high-quality resting state fMRI scans collected from 84 children (42 stuttering, 42 controls) were entered into an independent component analysis (ICA), yielding a number of distinct network connectivity maps (“components”) as well as expression scores for each component that quantified the degree to which it is expressed for each child. These expression scores were compared between stuttering and control groups’ first scans. In a second analysis, we examined whether the components that were most predictive of stuttering status also predicted persistence in stuttering.
Stuttering status, as well as stuttering persistence, were associated with aberrant network connectivity involving the default mode network and its connectivity with attention, somatomotor, and frontoparietal networks. The results suggest developmental alterations in the balance of integration and segregation of large-scale neural networks that support proficient task performance including fluent speech motor control.
This study supports the view that stuttering is a complex neurodevelopmental disorder and provides comprehensive brain network maps that substantiate past theories emphasizing the importance of considering situational, emotional, attentional and linguistic factors in explaining the basis for stuttering onset, persistence, and recovery.
Effects of emotion on the acoustic parameters in adults who stutter: An exploratory study
2017, Journal of Fluency Disorders
Citation Excerpt :
Their increases in speed of movement, although nonsignificant suggests that their response to the emotional stimuli was similar to controls. However, the demand to increase their speed of movement may have exceeded their motoric capacity (Starkweather & Gottwald, 1990), resulting in a potential breakdown to occur. It is possible that changes in articulatory extent was an attempt to stabilize the system.

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The demands and capacities model II: Clinical applications

Abstract

Journal of Fluency Disorders

Why do I talk so bad when I feel so good?

Case studies in language overstimulation

The Rate of Speech in Normal Preschool Children

The Syndrome of Stuttering

The Skilled Helper: Model, Skills and Methods for Effective Helping

The prognosis of stuttering in children